Provider Demographics
NPI:1689052839
Name:COOLIDGE, ROSS D (DO)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:D
Last Name:COOLIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ROSS
Other - Middle Name:D
Other - Last Name:BEHYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:355 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3167
Mailing Address - Country:US
Mailing Address - Phone:312-238-1000
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER CROSS BLVD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9509
Practice Address - Country:US
Practice Address - Phone:815-300-2911
Practice Address - Fax:815-300-4671
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036-149242208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program